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. 2016 Nov 3;6(11):e012675.
doi: 10.1136/bmjopen-2016-012675.

Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK

Myriam Gharbi  1 , Katja Doerholt  2 , Stefania Vergnano  3 , Julia Anna Bielicki  3 , Stéphane Paulus  4 , Esse Menson  5 , Andrew Riordan  4 , Hermione Lyall  6 , Sanjay Valabh Patel  7 , Jolanta Bernatoniene  8 , Ann Versporten  9 , Maggie Heginbothom  10 , Herman Goossens  9 , Mike Sharland  2   3 ; ARPEC project Group members
Affiliations

Using a simple point-prevalence survey to define appropriate antibiotic prescribing in hospitalised children across the UK

Myriam Gharbi et al. BMJ Open. .

Abstract

Background: The National Health Service England, Commissioning for Quality and Innovation for Antimicrobial Resistance (CQUIN AMR) aims to reduce the total antibiotic consumption and the use of certain broad-spectrum antibiotics in secondary care. However, robust baseline antibiotic use data are lacking for hospitalised children. In this study, we aim to describe, compare and explain the prescription patterns of antibiotics within and between paediatric units in the UK and to provide a baseline for antibiotic prescribing for future improvement using CQUIN AMR guidance.

Methods: We conducted a cross-sectional study using a point prevalence survey (PPS) in 61 paediatric units across the UK. The standardised study protocol from the Antibiotic Resistance and Prescribing in European Children (ARPEC) project was used. All inpatients under 18 years of age present in the participating hospital on the day of the study were included except neonates.

Results: A total of 1247 (40.9%) of 3047 children hospitalised on the day of the PPS were on antibiotics. The proportion of children receiving antibiotics showed a wide variation between both district general and tertiary hospitals, with 36.4% ( 95% CI 33.4% to 39.4%) and 43.0% (95% CI 40.9% to 45.1%) of children prescribed antibiotics, respectively. About a quarter of children on antibiotic therapy received either a medical or surgical prophylaxis with parenteral administration being the main prescribed route for antibiotics (>60% of the prescriptions for both types of hospitals). General paediatrics units were surprisingly high prescribers of critical broad-spectrum antibiotics, that is, carbapenems and piperacillin-tazobactam.

Conclusions: We provide a robust baseline for antibiotic prescribing in hospitalised children in relation to current national stewardship efforts in the UK. Repeated PPS with further linkage to resistance data needs to be part of the antibiotic stewardship strategy to tackle the issue of suboptimal antibiotic use in hospitalised children.

Keywords: Antimicrobials resistance; Benchmarking; Paediatric practice; Quality indicators; Surveillance.

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Conflict of interest statement

Conflicts of Interest: None declared.

Figures

Figure 1
Figure 1
Funnel plot comparing hospital prescribing in the UK using proportion of children on antibiotics.
Figure 2
Figure 2
Total prescribed antibiotics (DDD/100 inpatients) per age class and type of hospital across the UK during the point prevalence survey in 2011–1012. DDD, defined daily doses.
See this image and copyright information in PMC

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